Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA.
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
AIDS Patient Care STDS. 2021 Apr;35(4):103-109. doi: 10.1089/apc.2020.0262.
Adolescents (13-24 years of age) account for more than one-fifth of new HIV diagnoses yearly, and the United States has one of the highest rates of adolescent pregnancy among high resource countries. However, there is limited information on the characteristics and outcomes of adolescents living with HIV (ALWHIV) during pregnancy and differences with pregnancy in adults living with HIV. We performed a retrospective cohort study to compare demographic characteristics, HIV viral suppression, and pregnancy outcomes in adolescents ( = 90) as compared with adults ( = 250) in an urban HIV pregnancy clinic from 2003 to 2015. Seventy-one women overall were diagnosed with HIV during pregnancy (adolescents, 25/90; adults, 46/250). One-fifth of adolescents acquired HIV perinatally. Adolescents were more likely than adults to have unintended pregnancy (83.6% vs. 68.7%, = 0.016) and were less likely to be virally suppressed at delivery (50.0% vs. 69.7% overall, = 0.001; 48.0% vs. 78.2% in postuniversal antiretroviral therapy era, = 0.007%). Over one-third of adolescents reported a history of any illicit substance use, and adolescents were more likely than adults to use marijuana during pregnancy (29.2% vs. 16.9%, = 0.013). Adolescents were less likely to experience preterm labor (11.0% vs. 24.1%, = 0.012) or preterm premature rupture of membranes (3.7% vs. 16.7%, = 0.003). There was one case of maternal-fetal transmission, which occurred in an adult pregnancy. Despite the high rate of unintended pregnancy, one-third of adolescents were discharged without an identified contraception plan. We identify several opportunities for intervention to improve reproductive health outcomes in ALWHIV.
青少年（13-24 岁）占每年新诊断出的 HIV 病例的五分之一以上，美国是高资源国家中青少年怀孕率最高的国家之一。然而，关于怀孕期间感染 HIV 的青少年（ALWHIV）的特征和结局，以及与成年 HIV 感染者的差异，信息有限。我们进行了一项回顾性队列研究，比较了 2003 年至 2015 年在一家城市 HIV 妊娠诊所中，青少年（90 例）和成年 HIV 感染者（250 例）的人口统计学特征、HIV 病毒抑制和妊娠结局。共有 71 名女性在怀孕期间被诊断出 HIV（青少年 25/90；成年人 46/250）。五分之一的青少年是围产期感染 HIV 的。与成年人相比，青少年更有可能意外怀孕（83.6% vs. 68.7%， = 0.016），分娩时病毒抑制率更低（总体 50.0% vs. 69.7%， = 0.001；后普遍抗逆转录病毒治疗时代 48.0% vs. 78.2%， = 0.007）。超过三分之一的青少年报告有任何非法药物使用史，且青少年在怀孕期间更有可能使用大麻（29.2% vs. 16.9%， = 0.013）。青少年早产（11.0% vs. 24.1%， = 0.012）或胎膜早破（3.7% vs. 16.7%， = 0.003）的发生率较低。只有 1 例母婴传播发生在成年女性妊娠期间。尽管意外怀孕率很高，但三分之一的青少年在出院时没有确定的避孕计划。我们确定了一些干预机会，以改善 ALWHIV 的生殖健康结局。
